A Hearty Defense Against Chemo's Harm

Monitoring myocardial damage with echocardiography in chemotherapy patients

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Cancer treatment is frequently a delicate balance between too much and not enough. Part of the therapy includes careful evaluation of how the patient is handling the side effects.

Two studies were recently published on the importance of using echocardiography (echo) to monitor heart damage during chemotherapy.

Several common cancer drugs are known to cause heart damage, including Daunomycin (Daunorubicin), Adruci (5–Fluoroouracil), Xeloda (capecitabine), and Herceptin (trastuzumab).

"Ask your doctor to evaluate your cardiac function during chemotherapy."

The studies were presented at the annual meeting of The European Society of Cardiology in December. In the first study, Helder Dores, M.D. and her group from Centro Hospitalar Lisboa Ocidental in Portugal found solid evidence of decreased heart function in cancer patients treated with Herceptin.

Dr. Dores followed 51 breast cancer patients treated with Herceptin, and found that three months after chemotherapy, thirty of the patients scored slightly worse on tests looking at left ventricular systolic function (LVSF).

Furthermore, ten patients had the first signs of progression to heart failure as seen on echocardiography, referred to as impaired ventricular relaxation.

"Patients with [these signs] are known to be at higher risk for progression to advanced stages... [high risk patients should] be subject to more frequent evaluations both during and after therapy," says Dr. Dores.

In the second study on echocardiography presented at the conference, a team from Romania looked at damage prevention. Twenty-six patients were given heart drugs Prinivil (lisinopril) and Crestor (rosuvastatin) during their chemotherapy with Ellence (epirubicin).

Heart function was monitored and compared to a group of 31 chemotherapy patients that were not given any protective drugs. The study states that heart function showed a "much more rapid deterioration," without the heart drugs, but raw numbers were not published.

Co-author Andreea Parv, M.D., from the University of Medicine in Cluj-Napoca, Romania, explains that "both ACE inhibitors and statins are known to play an important role in reducing oxidative stress and inflammation at the level of the heart muscle cells." 

The European Society of Cardiology has called for larger studies to be done, noting that nearly a fifth of cancer patients are forced to stop chemotherapy because of drug-related damage to the heart. The society's guidelines for chemotherapy state that "clinical examination, EKG and echocardiography are always recommended before each cycle and every 4 – 12 weeks after the cycle an during the complete treatment... Echocardiography plays a definitive role for this assessment."

The monthly cost of a Prinivil prescription runs about $50, Crestor $100. Both protective drugs are now widely available in generic forms.

The research will be considered preliminary until it's published in a peer-reviewed journal. No financial conflicts of interest were disclosed by the Society or individual researchers.  

Reviewed by: 
Review Date: 
January 24, 2012
Last Updated:
January 29, 2012